Mass Casualty Incident (MCI) Guidelines

• The standard operating guideline provides guidelines to efficiently triage, treat, and transport patients of mass casualty incidents (MCI).
• The guideline applies to all Fire Rescue Personnel.
• Attachments include MCI Dispatch Protocols, MCI Levels Flow Chart, MCI Responsibilities Check List, Start, Jump Start, and TECC Flow Charts.

MCI Definition

• An MCI exceeds the capabilities of the first arriving units.
• MCIs are classified by levels based on patient numbers:
• Level 1: 5-10 patients
• Level 2: 11-20 patients
• Level 3: 21-100 patients
• Level 4: 101-1000 patients
• Level 5: over 1000 patients
• Examples of MCI types: shooting, explosive, collapse, plane crash, vehicle accident, chemical, biological, radiological, and nuclear.

Communication Center

• Refer to MCI Dispatch Protocols for unit allocation and hospital notifications.

Incident Command System (ICS)

• Refer to SOG 200-02 Incident Command Sequence.
• Depending on the MCI's size and complexity, the Incident Command Structure includes assignments such as hazard mitigation, triage, treatment, transport, staging, and rehab.

Specialized Resources

• Fire Operations Officer may contact the State Warning Point or request resources outside Palm Beach County, based on the MCI cause.
• Internal Fire Rescue resources can be requested (refer to SOG 200-01 Area Command, Fire Rescue Reservist PPM FR-O-703) for assistance.
• The Fire Operations Officer maintains a list of Fire Rescue and non-Fire Rescue resources that may be beneficial in MCIs, including:
• Tactical Command Unit (TCU) - command bus
• Area Command Team
• Incident Management Team
• Support 81 - contains resources (backboards, ribbons, medical kits) for about 200 patients
• Disaster Response Unit (DRU).
• Tactical 34 – Technical Rescue Team equipment (specialized equipment)
• Inventory Specialist - stocks medical supply rooms at fire stations

Emergency Scene Activities

• The below responsibilities are for the person in charge of the stated categories.
• For Staging Responsibilities: Refer to SOG 110-02 Response to Violent Incidents and SOG 200-05 Staging Levels.

First Arriving Unit Responsibilities

• Arrival report and establish Incident Command according to SOG 200-02 Incident Command Sequence.
• Perform a 360-degree size up
• Identify any Exclusion Zone
• Declare MCI “Level” and "Type"
• Begin initial Triage (START, JUMP-START, and TECC) follow Fire Rescue Medical Protocols.
• Assign incoming units based on incident priorities (L.I.P.E.).
• Consider additional resources.
• Designate Staging

First Arriving Chief Officer Responsibilities

• Utilize laminated field guide(s).
• Utilize MCI vests.
• Ensure any Exclusion Zone is identified and communicated.
• Follow SOG 200-02 Incident Command Sequence: consider Unified Command, establish/assign units, consider medical oversight, consider multiple TAC channels.
• Confirm and Declare MCI “Level” and "Type"
• Consider additional resources
• Update the Communication Center on the number of patients and categories

Safety Officer Responsibilities

• Refer to SOG 200-03 Safety Officer
• If necessary, request Law Enforcement to provide physical security to ensure Exclusion Zone is isolated.

Hazard Mitigation

• These are incident dependent (examples include: Fire Suppression, Structural Stabilization, Vehicle Stabilization, Fuel Leak Containment, etc...).

Triage Responsibilities

• Utilize MCI vest.
• Ensure any Exclusion Zone is identified and communicated.
• Ensure all patients are triaged (START, JUMP-START, and TECC) according to Fire Rescue Medical Protocols; carry Trauma Rapid Response Kit
• Ensure "walking wounded” are escorted to Treatment.
• Ensure that all areas have been checked for patients.
• Utilize Litter Bearers for movement of patients to Treatment, coordinate movement based on priority, and additional Backboards used to assist in patient movement can be requested from support 81, rescues in staging, or the inventory specialist
• Update Incident Command with the number of patients, patient categories, and additional resources needed.

Treatment Responsibilities

• Utilize MCI vest.
• Establish Treatment in close proximity to Transport, large enough, and utilize high visibility tape, tarps, or cones to identify area.
• Supervise medical care according to Fire Rescue Medical Protocols.
• Ensure enough equipment is available; consider requesting Inventory Specialist.
• Ensure contaminated patients have been Decontaminated prior to entry into Treatment; consider utilizing DRU for decontamination.
• Ensure patients are moved from Treatment to Transport in priority order.
• Ensure secondary assessment of all patients, utilize Metag, leave original triage ribbon in place to indicate improvement or deterioration of patient.
• All Fire Rescue Medical Protocols apply in Treatment.
• Establish communications with Medical and Transport to coordinate patient transport.
• Keep Incident Command updated with frequent progress reports.

Transport Responsibilities

• Utilize MCI vest
• Establish Transport in a location that allows for efficient entry and exit of Treatment and the Transport Staging location, and utilize Law Enforcement to assist as necessary
• Establish communications with Landing Zone for utilization of Trauma Hawk.
• Coordinate the transport of patients by priority order.
• Patients meeting Trauma Alert status continue to be transported to designated Trauma facilities until the facility goes on “bypass”; once on “bypass”, the patient should be transported to the closets available facility.
• Utilize a "Transport Log” to record the patient Met Tag ID number, destination hospital, and transport unit number.
• Consider Need for Medical Communications Coordinator.
• Keep Incident Command updated with frequent progress reports.

Medical Communications Coordinator Responsibilities

• These responsibilities default to Transport should the Medical Communication Coordinator not be established.
• Advise Destination Hospitals, which include, the number of incoming patients, triage status of incoming patients, and mode of transportation to hospital.
• Advise Communications Center for transport unit, number of patients, metag numbers, and the hospital name

Communication Center Responsibilities

• The Communication Center shall contact the correct number of hospitals and patch them together, and then advise Transport to switch to the appropriate TAC channel(s)
• Refer to SOG 420-08 Rehabilitation for Rehabilitation Responsibilities

Post Incident

• Refer to SOG 430-01 After Action Review.
• Refer to Critical Incident Stress Management (PPM FR-T-501) and Crisis Mitigation Program (PPM FR-T-502).
• A Formal After Action Review is required for a MCI Level 3 or greater.

Documentation

• See Incident Reporting (PPM FR-M-201).